Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR

Xi, Wang; Bieliauskas, Gintautas; Wong, Ivan; Bajoras, Vilhelmas; Xiong, Tian-Yuan; Zhang, Yi; Kofoed, Klaus F.; Chen, Mao; Søndergaard, Lars

doi:10.1016/j.jcin.2021.11.010

Cited by 22 publications

(30 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The percentage of patients with only two coronary cusps is very low [ 9 , 10 ]. In most patients the LMCA takes off from the middle part of the LCC [ 11 ]. The LMCA ostium usually faces the NCC-RCC commissure [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Determination of Optimal Fluoroscopic Angulations for Left Main Coronary Artery Ostial Interventions: 3-Dimensional Computed Tomography Validation

Sheng

Jing

et al. 2022

Journal of Interventional Cardiology

View full text Add to dashboard Cite

Background. Current recommendations for the best views for the left main coronary artery (LMCA) ostium intervention are empirical. Objectives. To determine the optimal projection to visualize the LMCA ostium using only fluoroscopy. Methods. The optimal projection to visualize the LMCA ostium was determined using fluoroscopic images of superimposing the lowest points of the distal ends of two J tipped wires in the noncoronary cusp (NCC) and right coronary cusp (RCC). This was validated independently using 3-dimensional computed tomography (3D-CT) reconstruction. Results. Satisfactory images of the overlapping wires in NCC and RCC could be obtained in 90% (45/50). Between the fluoroscopic and the 3D-CT reconstruction approaches, the mean difference for NCC and RCC overlapping at horizontal axes is -1.8 with a 95% limit of agreement between −3.94 and 0.34 p = 0.10 and at vertical axes −1.6 with a 95% limit of agreement between −3.46 and 0.26 p = 0.09 ; and the mean difference for the optimal projection to visualize the LMCA ostium at horizontal axes is −3.22 with a 95% limit of agreement between -7.26 and 0.81 p = 0.11 and at vertical axes −2.31 with a 95% limit of agreement between −5.83 and 1.21 p = 0.09 . The 3D angulation deviation for the optimal projection to visualize the LMCA ostium was 8.5° ± 4.7° when the LMCA ostium faced the NCC-RCC commissure (n = 32) and 22.3° ± 16.0° p = 0.009 when it did not (n = 13). Conclusions. The optimal projection for LMCA ostial intervention can be determined using fluoroscopic images of superimposing wires in the NCC and RCC when the LMCA ostium faces the NCC-RCC commissure, as was the case in 71% of the patients studied.

show abstract

Section: Discussionmentioning

confidence: 99%

Determination of Optimal Fluoroscopic Angulations for Left Main Coronary Artery Ostial Interventions: 3-Dimensional Computed Tomography Validation

Sheng

Jing

et al. 2022

Journal of Interventional Cardiology

View full text Add to dashboard Cite

show abstract

“…In fact, the anatomic variability of different BAV types, location of raphe and coronary ostia may increase the risk of THV misalignment with respect to the coronaries ( 10 , 11 ). This concept has been recently described by Wang et al in a pre-procedural computed tomography (CT) study, which showed that BAV carries higher cusp asymmetry and more pronounced coronary ostia eccentricity as compared to TAV ( 12 ). However, whether the anatomic variability of BAV represents a potential Achille’s heel of current commissural alignment techniques remains yet to be investigated.…”

Section: Introductionmentioning

confidence: 85%

“…Additional measures, which were evaluated in the 50-70% phase of the cardiac cycle at the supra-annular level, included: the angle between the non-fused commissures, the angle between the non-fused commissures and the raphe, the angle between the coronary ostia and the non-fused commissures, and the angle between the coronary ostia and the raphe ( Figure 2A ). As previously described ( 12 ), based on the angle between the commissures delimiting the largest cusp (non-coronary cusp – NCC, or right coronary cusp – RCC, or left coronary cusp – LCC), BAVs were classified as: a) symmetric (120°-125°); b) mildly asymmetric (125°-135°); c) moderately asymmetric (130°-135°); and d) severely asymmetric (> 135°). Likewise, based on the angle deviation between each coronary ostium and the bisector of the corresponding cusp, the eccentricity of coronary ostia was classified as ( 12 ): a) centered (0°-10°); b) mildly eccentric (10-20°); moderately eccentric (20°-30°); and d) severely eccentric (>30°) ( Figure 2B ).…”

Section: Methodsmentioning

confidence: 99%

“…As previously described ( 12 ), based on the angle between the commissures delimiting the largest cusp (non-coronary cusp – NCC, or right coronary cusp – RCC, or left coronary cusp – LCC), BAVs were classified as: a) symmetric (120°-125°); b) mildly asymmetric (125°-135°); c) moderately asymmetric (130°-135°); and d) severely asymmetric (> 135°). Likewise, based on the angle deviation between each coronary ostium and the bisector of the corresponding cusp, the eccentricity of coronary ostia was classified as ( 12 ): a) centered (0°-10°); b) mildly eccentric (10-20°); moderately eccentric (20°-30°); and d) severely eccentric (>30°) ( Figure 2B ).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Definition of trAnscatheter heart Valve orIeNtation in biCuspId aortic valve: The DA VINCI pilot study

Tarantini

Fabris

Fovino

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

ObjectivesTo assess the impact of conventional transcatheter heart valve (THV) commissural alignment techniques on THV/coronary overlap and coronary access (CA) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV).BackgroundSpecific Evolut Pro/Pro + and Acurate Neo2 THV orientations are associated with reduced neo-commissural overlap with coronary ostia in tricuspid aortic anatomy. Whether standard orientation techniques are effective also in the setting of BAV anatomy has not been studied.MethodsThe DA VINCI (Definition of trAnscatheter aortic Valve orIeNtation in biCuspId aortic valve) pilot study is a prospective registry enrolling consecutive patients with severe BAV stenosis undergoing TAVR with last generation supra-annular tall-frame THVs implanted with a cusp overlap view-based commissural alignment. Patients underwent pre- and post-TAVR computed tomography (CT) and coronary angiography. The study endpoint was the rate of favorable THV/coronary overlap, defined as an angle > 40° between the THV commissural post and coronary ostia. Other endpoints were the rates of successful THV alignment with respect to the raphe and of selective CA after TAVR. Moreover, different virtual THV alignment models were tested to identify which one would produce the lower degree of THV/coronary overlap.ResultsThirty-four patients with type 1 BAV with right-left raphe undergoing TAVR (23 with Evolut Pro/Pro + and 11 with Acurate Neo2) were included. At pre-TAVR CT, moderate/severe cusp asymmetry was found in 50% of patients, severe coronary ostia eccentricity was observed in 47.1% for the RCA vs. 8.8% for the LCA (P < 0.007). Correct TVH orientation was achieved in 29 cases. At post-TAVR CT, optimal THV alignment/mild misalignment to the raphe was observed in 86.2%, but a moderate/severe overlap with the coronaries was seen in 13.7% for the RCA and 44.8% for the LCA (P = 0.019). After TAVR, selective RCA cannulation was possible in 82.8% vs. 75.9% for the LCA (P = 0.74), while combined selective CA of both coronaries was possible in less than two-thirds of the patients. Virtual THV alignment in the coronary ostia overlap view assuming a hypothetical circular THV expansion would produce an optimal THV/coronary overlap in almost 90% of cases.ConclusionGiven cusp asymmetry and coronary ostia eccentricity of BAV combined with potential THV asymmetrical expansion, conventional commissural alignment techniques are associated with higher rates of THV misalignment and of moderate/severe neo-commissure overlap with the coronary ostia as compared to tricuspid aortic stenosis, resulting in lower rates of selective CA after TAVR. A modified THV orientation technique based on the coronary ostia overlap view might be preferable in BAV patients.

show abstract

“…In 97% of BAV patients, the right and left cusps are slightly displaced from the commissure. In 93% of BAV patients, a displacement of less than 20° was noted between the right and left coronary cusps and between the right and left coronary arteries as centered lines [ 96 ].…”

Section: Imaging Diagnosticmentioning

confidence: 99%

Patients with Bicuspid Aortopathy and Aortic Dilatation

Nappi

Giacinto

Lusini

et al. 2022

JCM

View full text Add to dashboard Cite

(1) Background: Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. Alteration of ascending aorta diameter is a consequence of shear stress alterations due to haemodynamic abnormalities developed from inadequate valve cusp coaptation. (2) Objective: This narrative review aims to discuss anatomical, pathophysiological, genetical, ultrasound, and radiological aspects of BAV disease, focusing on BAV classification related to imaging patterns and flux models involved in the onset and developing vessel dilatation. (3) Methods: A comprehensive search strategy was implemented in PubMed from January to May 2022. English language articles were selected independently by two authors and screened according to the following criteria. (4) Key Contents and Findings: Ultrasound scan is the primary step in the diagnostic flowchart identifying structural and doppler patterns of the valve. Computed tomography determines aortic vessel dimensions according to the anatomo-pathology of the valve. Magnetic resonance identifies hemodynamic alterations. New classifications and surgical indications derive from these diagnostic features. Currently, indications correlate morphological results, dissection risk factors, and genetic alterations. Surgical options vary from aortic valve and aortic vessel substitution to aortic valve repair according to the morphology of the valve. In selected patients, transcatheter aortic valve replacement has an even more impact on the treatment choice. (5) Conclusions: Different imaging approaches are an essential part of BAV diagnosis. Morphological classifications influence the surgical outcome.

show abstract

Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR

Cited by 22 publications

References 20 publications

Determination of Optimal Fluoroscopic Angulations for Left Main Coronary Artery Ostial Interventions: 3-Dimensional Computed Tomography Validation

Determination of Optimal Fluoroscopic Angulations for Left Main Coronary Artery Ostial Interventions: 3-Dimensional Computed Tomography Validation

Definition of trAnscatheter heart Valve orIeNtation in biCuspId aortic valve: The DA VINCI pilot study

Patients with Bicuspid Aortopathy and Aortic Dilatation

Contact Info

Product

Resources

About